Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 159223 | MA |
N | 207PP0204X | Pediatric Emergency Physician | 159223 | MA |
NPI | 1649220955 |
---|---|
Provider Name | Dr. Irene Tien |
First Address | Boston, MA 02116-6137 |
Second Address | Boston, MA 02118-2644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3193233 | (05) | MA |
G89104 | (02) | MA |